Remy
Administrator
I struggled with where to put this post. And I struggled with the title too. For those of you that know me, or have been following my posts for a while, you probably know that I've been sick for about 7 years now. My first bout of illness was following mono in my senior year of high school. After that, my illness waxed and waned (but mostly waned) through my 20s until I was hit by a motorcycle crossing the street one night on my way home. Then it was a long 8 year downward stretch into the mostly housebound state I find myself in today.
Over the course of the past 7 years, I've basically tried everything available to me in terms of meds and supplements (except Rituximab because I'm not yet convinced that's the answer). Antivirals and antibiotics, IV and oral and every supplement known to man practically. And while I've made some improvements, I'm still not *better*.
I give this backstory so that my waffling on the cause of MECFS makes more sense...I've gone from being certain it was a pathogen of some sort, probably herpes family, to being certain it was Lyme disease, to being certain it was mold, to finally being certain it was just the immune system gone haywire and reacting spectacularly to everything even when nothing was there anymore.
And now I'm leaning back towards a viral pathogen at the heart of the immune system insanity.
So here goes nothing! Follow along and let me know where things don't make sense or if there are errors in my thinking...
I have been interested in the ion channels, like many other MECFS researchers, for a while now. There are many threads and articles that discuss this topic but basically the ion channels are pores in the cell membrane that allow specific ions to pass through. Typical examples of these type of channels are the sodium/potassium pump which pumps out cellular waste and calcium channels.
It turns out calcium channels are pretty darn important in the proper functioning of just about everything in the body. Calcium is one of those ions that is supposed to be higher in concentration (by about 10,000x) outside of the cell in the blood and extracellular fluid. This concentration gradient is vital for the proper functioning of muscles, glial cells and neurotransmission.
Basically high intracellular calcium can cause most all the symptoms of MECFS. Fatigue, muscle recovery problems, neuroendocrine issues, mast cell issues, POTS...etc etc. (But don't worry, I'm not at all saying this is true for everyone with MECFS or that I have the cure. I'm just thinking out loud for now in the hopes that it will make sense to others too).
So it makes sense then that calcium channel blockers are sometimes helpful in symptom management in MECFS. Calcium channel blockers block (go figure) the calcium channels so that the intracellular concentration of calcium is somewhat reduced. There are several threads on this forum on that topic as well if you search for verapamil.
Verapamil is a typical calcium channel blocker and it basically reads like a wonder drug for MECFS in all the symptoms it can potentially help to correct. But so far I don't know of anyone who's been cured by verapamil unfortunately.
Calcium also affects mitochondrial function with high intracellular calcium levels causing conformational changes which make the mitochondria stop functioning well. This consequently leads to mitochondrial dysfunction but it isn't a genetic mitochondrial disorder...it's caused by the increased intracellular calcium.
Other things that seem to be helpful to us are NMDA blockers of which @Hip has a fabulous list...this is likely because the NMDA receptor also helps to indirectly lower intracellular calcium concentrations but in kind of a roundabout way.
Here's an abstract (BTW, I have all these papers if anyone wants to read them, you are welcome to PM me). This abstract talks about how NMDA antagonists and calcium channel antagonists protect against intracellular calcium increase under low oxygen conditions. Sounds pretty familiar, right?
Brain Res Bull. 2001 Mar 1;54(4):413-9.
Turns out the hippocampus in the brain is pretty vital for MECFS patients as well.
Med Hypotheses. 2016 Jan;86:30-8. doi: 10.1016/j.mehy.2015.11.024. Epub 2015 Nov 27.
So that isn't the greatest article above but it does make the point that the hippocampus is pretty important for healthy functioning. @Cort makes this point as well in this article.
http://www.cortjohnson.org/blog/2015/02/16/pain-brain-hippocampal-atrophy-found-fibromyalgia/
OK, so when are we getting to the pathogen part, you ask?
It all sort of started clicking when I was reading Dr Afrin's new book on mast cell disorders (which is fascinating, BTW, and I'm only about halfway through). Mast cell disease looks to me to be a result of high intracellular calcium. And imatinib helps to lower intracellular calcium through it's action as a tyrosine kinase inhibitor. In the book, he says that he has had some success with mast cell patients with a drug called imatinib (brand name Gleevec). Imatinib is a drug primarily used in chemo to treat certain types of leukemia. It's a tyrosine kinase inhibitor.
https://www.mhealth.org/blog/2015/a...-credits-m-health-expert-with-saving-her-life
Over the course of the past 7 years, I've basically tried everything available to me in terms of meds and supplements (except Rituximab because I'm not yet convinced that's the answer). Antivirals and antibiotics, IV and oral and every supplement known to man practically. And while I've made some improvements, I'm still not *better*.
I give this backstory so that my waffling on the cause of MECFS makes more sense...I've gone from being certain it was a pathogen of some sort, probably herpes family, to being certain it was Lyme disease, to being certain it was mold, to finally being certain it was just the immune system gone haywire and reacting spectacularly to everything even when nothing was there anymore.
And now I'm leaning back towards a viral pathogen at the heart of the immune system insanity.
So here goes nothing! Follow along and let me know where things don't make sense or if there are errors in my thinking...
I have been interested in the ion channels, like many other MECFS researchers, for a while now. There are many threads and articles that discuss this topic but basically the ion channels are pores in the cell membrane that allow specific ions to pass through. Typical examples of these type of channels are the sodium/potassium pump which pumps out cellular waste and calcium channels.
It turns out calcium channels are pretty darn important in the proper functioning of just about everything in the body. Calcium is one of those ions that is supposed to be higher in concentration (by about 10,000x) outside of the cell in the blood and extracellular fluid. This concentration gradient is vital for the proper functioning of muscles, glial cells and neurotransmission.
Basically high intracellular calcium can cause most all the symptoms of MECFS. Fatigue, muscle recovery problems, neuroendocrine issues, mast cell issues, POTS...etc etc. (But don't worry, I'm not at all saying this is true for everyone with MECFS or that I have the cure. I'm just thinking out loud for now in the hopes that it will make sense to others too).
So it makes sense then that calcium channel blockers are sometimes helpful in symptom management in MECFS. Calcium channel blockers block (go figure) the calcium channels so that the intracellular concentration of calcium is somewhat reduced. There are several threads on this forum on that topic as well if you search for verapamil.
Verapamil is a typical calcium channel blocker and it basically reads like a wonder drug for MECFS in all the symptoms it can potentially help to correct. But so far I don't know of anyone who's been cured by verapamil unfortunately.
Calcium also affects mitochondrial function with high intracellular calcium levels causing conformational changes which make the mitochondria stop functioning well. This consequently leads to mitochondrial dysfunction but it isn't a genetic mitochondrial disorder...it's caused by the increased intracellular calcium.
Other things that seem to be helpful to us are NMDA blockers of which @Hip has a fabulous list...this is likely because the NMDA receptor also helps to indirectly lower intracellular calcium concentrations but in kind of a roundabout way.
Here's an abstract (BTW, I have all these papers if anyone wants to read them, you are welcome to PM me). This abstract talks about how NMDA antagonists and calcium channel antagonists protect against intracellular calcium increase under low oxygen conditions. Sounds pretty familiar, right?
Brain Res Bull. 2001 Mar 1;54(4):413-9.
Characteristics of protective effects of NMDA antagonist and calcium channel antagonist on ischemic calcium accumulation in rat hippocampal CA1 region.
Kubo T1, Yokoi T, Hagiwara Y, Fukumori R, Goshima Y, Misu Y.
Abstract
Effects of excitatory amino acid receptor antagonists and voltage-dependent Ca(2+) channel antagonists on ischemia-induced intracellular free Ca(2+) accumulation in rat hippocampal slices were examined. Ischemia caused a large Ca(2+) accumulation in CA1 region but a small Ca(2+) accumulation in CA3 and dentate gyrus regions. When applied during ischemia, the NMDA receptor antagonist MK-801 ((+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]-cyclohepten-5,10-imine maleate) inhibited the ischemic Ca(2+) accumulation only in the CA1, but the non-NMDA receptor antagonist CNQX (6-cyano-7-nitroquinoxaline-2,3-dione) inhibited it in all the three regions. The L-type Ca(2+) channel antagonists nifedipine and verapamil inhibited the ischemic Ca(2+) accumulation only in the CA1 region, but omega-conotoxin, a N- and L-type Ca(2+) channel antagonist inhibited the Ca(2+) accumulation in all the three regions of the hippocampus. When applied after 5-min ischemia, nifedipine but not MK-801, inhibited sustained postiscehmic Ca(2+) elevation in the CA1 region but not in the CA3 and dentate gyrus regions. These findings suggest that the enhanced ischemia-induced Ca(2+) accumulation in the CA1 region is mediated via activation of both NMDA receptors and L-type-like Ca(2+) channels. It appears that sustained postischemic Ca(2+) elevation in the CA1 region is mediated via activation of L-type-like Ca(2+) channels, but not of NMDA receptors.
Turns out the hippocampus in the brain is pretty vital for MECFS patients as well.
Med Hypotheses. 2016 Jan;86:30-8. doi: 10.1016/j.mehy.2015.11.024. Epub 2015 Nov 27.
The role of the hippocampus in the pathogenesis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).
Saury JM1.
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a severe acquired illness characterized by a profound sensation of fatigue, not ameliorated by rest and resulting in a substantial decrease in the amount and quality of occupational, social and recreational activities. Despite intense research, the aetiology and pathogenesis of ME/CFS is still unknown and no conclusive biological markers have been found. As a consequence, an accepted curative treatment is still lacking and rehabilitation programmes are not very effective, as few patients recover. Increased knowledge of the mechanisms leading to the emergence and maintenance of the illness is called for. In this study, I will put forth an alternative hypothesis to explain some of the pathologies associated with ME/CFS, by concentrating on one of the major strategic organs of the brain, the hippocampus. I will show that the ME/CFS triggering factors also impact the hippocampus, leading to neurocognitive deficits and disturbances in the regulation of the stress system and pain perception. These deficits lead to a substantial decrease in activity and to sleep disorders, which, in turn, impact the hippocampus and initiate a vicious circle of increased disability.
So that isn't the greatest article above but it does make the point that the hippocampus is pretty important for healthy functioning. @Cort makes this point as well in this article.
http://www.cortjohnson.org/blog/2015/02/16/pain-brain-hippocampal-atrophy-found-fibromyalgia/
OK, so when are we getting to the pathogen part, you ask?
It all sort of started clicking when I was reading Dr Afrin's new book on mast cell disorders (which is fascinating, BTW, and I'm only about halfway through). Mast cell disease looks to me to be a result of high intracellular calcium. And imatinib helps to lower intracellular calcium through it's action as a tyrosine kinase inhibitor. In the book, he says that he has had some success with mast cell patients with a drug called imatinib (brand name Gleevec). Imatinib is a drug primarily used in chemo to treat certain types of leukemia. It's a tyrosine kinase inhibitor.
https://www.mhealth.org/blog/2015/a...-credits-m-health-expert-with-saving-her-life
Although she was always very sensitive to allergens, Jennifer’s overall health began to nosedive in her early 20s. A Maryland resident, Jen was forced to resign from her job when variety of physical symptoms—including severe headaches, cognitive difficulties and fever-like problems—began to affect her health.
In 2010, Jennifer was misdiagnosed with Lyme disease. Treatment for Lyme disease did not alleviate her symptoms, which became more severe over time. Jennifer began experiencing seizure-like episodes, slurred speech, insomnia and muscle weakness.
“I was so sick and pretty much bedbound for a couple of years. My parents had to help me to the bathroom two feet away,” Jennifer said. “No doctor seemed to have any clue what was happening.”
In 2013, Jennifer was diagnosed with postural orthostatic tachycardia syndrome (POTS), which is marked by a drop in blood pressure when standing. That same year, she was also diagnosed with Ehlers-Danlos syndrome (EDS), a group of genetic disorders that primarily affect connective tissue in skin, joints and blood vessel walls.
But neither diagnosis seemed to account for all of Jennifer’s difficulties, which continued to become more severe. At times, she felt the tissues of her throat closing—a life-threatening occurrence known as anaphylaxis.
In 2013, the two doctors that diagnosed her with POTS and EDS both referred her to Lawrence Afrin, MD, who was transitioning from the Medical University of South Carolina to a new position at the University of Minnesota Medical Center. Afrin is one of the most prominent international experts on mast cell activation syndrome (MCAS).
Finally, a diagnosis and solution
When she learned Afrin was moving to the University of Minnesota, Jennifer—desperate to find a solution to her bevy of erratic and mysterious symptoms—called ahead.
In July 2014, Jennifer met with Afrin for her first appointment. After carefully examining her medical history and lab test results, Afrin told her that mast cell activation syndrome might be the “root diagnosis” to most if not all of her symptoms. Afrin ordered lab tests, but that day Jennifer’s symptoms were in remission and the tests were largely inconclusive—which is not unusual for MCAS patients.
“MCAS is a chameleon, difficult to identify for many reasons,” Afrin said. “It presents with different symptoms—which are often inflammatory or allergic in nature—to different degrees in different places in the body.” To make matters worse, many healthcare providers are not yet familiar with the condition. Though more research on MCAS is emerging, relatively little information exists about the syndrome in medical literature.
At a follow-up appointment with Afrin months later, two of Jennifer’s lab results came back positive, including her level of histamine, which was five times the normal limit. Histamine is a chemical neurotransmitter that causes allergic responses. That day, Afrin diagnosed Jennifer with mast cell activation syndrome.
Mast cells, which release histamine, are a critical component of a person’s immune system. But in patients with mast cell activation syndrome, the mast cells are over-active. Many of Jennifer’s symptoms were actually allergic reactions—caused when her hyperactive mast cells responded.
At first, Afrin prescribed a series of medication trials to try to inhibit mast cell activity, but none helped significantly. Finally, Afrin recommended a trial of a low dose of the medication Gleevec, a non-chemotherapy medication often used to treat certain blood and other cancers.
"It was Dr. Afrin who saved my life"
Within nine days of starting Gleevec, Jennifer noticed a dramatic turnaround in her health.
Gleevec prevents a key mast cell element from activating, Afrin said, and in some patients halts or reduces allergic reactions.
“I went from on death’s door step to feeling—in between my now few reactions—mostly normal,” Jennifer said. “I was able to go off twelve medications including the bottle of Benadryl [I took] a day.”
Although Jennifer still receives treatment for her conditions, she credits Afrin with tipping the scales and helping her reclaim her life. She also thanks her online support groups and her family with supporting her through her extended medical journey.
“Out of the hundreds of doctors that I have seen, it was Dr. Afrin who saved my life,” Jennifer said. “Never once did I feel the need to ‘prove’ that my symptoms were real or of physical origin as I’ve had to with other physicians. He just believed me.”
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